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Many adult survivors of childhood cancer experience financial hardships
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Sixty-five percent of adult survivors of childhood cancer experienced financial hardships related to their earlier diagnosis, according to findings from a cross-sectional study.
These hardships affected their ability to afford insurance, plan for retirement and maintain healthy quality of life.
“Clinicians should consider screening financial problems through the risk factors derived from this study to identify target patients for further interventions, especially those having low family income, lower education background, middle-age working group and chronic health conditions,” I-Chan Huang, PhD, associate faculty member in the department of epidemiology and cancer control at St. Jude Children’s Hospital, told HemOnc Today. “Identifying survivors at risk financially and simply asking about their ability to pay for health care will alert the care team to better understand specific areas of financial problems and recommend resources for the survivor to address their issues.”
Survival rates for childhood cancer have increased. However, survivors often face challenges later in life including chronic health conditions and substandard health-related quality of life.
“Previous studies have shown that symptom complications, suicidal ideation and quality of life are influenced by treatment and late health effects,” Huang said.
However, little research has investigated the effects of treatment toxicity and human capital — measured via educational attainment, household income and employment — on financial hardship, and how financial hardship affects health-related quality of life, ability to acquire insurance and other factors.
Huang and colleagues evaluated data from 2,811 adult survivors of childhood cancer (mean age at evaluation, 31.8 years; mean years since diagnosis, 23.6 years) from the St. Jude Lifetime Cohort Study to investigate the prevalence, determinants and consequences of financial hardship. Overall, 57.8% of the cohort received treatment for hematological malignancies, 32% for solid tumors and 10.1% for central nervous system malignancies.
Investigators measured determinants and consequences of financial hardship — within material, psychological and behavioral domains — through a baseline survey and clinical evaluation. They measured symptoms in the domains of sensation abnormality, cardiac symptoms, pulmonary symptoms, pain, somatization, anxiety and depression; suicidal idealization independently; and health-related quality of life via Medical Outcomes Study 36-Item Short-Form Health Survey.
Huang and colleagues hypothesized that demographic and clinical factors could increase risk for financial hardship; human capital could overcome the influence of demographic and clinical factors on financial hardship; and financial challenges could affect health and life insurance affordability, retirement planning and health outcomes.
Survey results showed approximately 65% (95% CI, 63.9-67.5) of survivors reported hardship in at least one domain; 22.4% (95% CI, 20.8-24) reported material hardship, 51.1% (95% CI, 49.2-52.9) reported psychological hardship, and 33% (95% CI, 31.1-34.6) reported coping or behavioral hardship.
Survivors aged older than 40 years had increased risk for psychological (OR = 1.98; 95% CI, 1.38-2.85) and behavioral (OR = 2.08; 95% CI, 1.42-3.06) hardships compared with survivors aged 18 to 29.9 years.
Researchers found an annual household income of $39,999 or less to be a risk factor for material (OR = 3.04; 95% CI, 2.08-4.46), psychological (OR = 3.64; 95% CI, 2.76-4.8) and behavioral (OR = 4.95; 95% CI, 3.57-6.86) hardships compared with an $80,000 or higher annual household income.
Less than a high school education also appeared to be a risk factor for material (OR = 2.22; 95% CI, 1.45-3.42), psychological (OR = 1.75; 95% CI, 1.18-2.62) and behavioral (OR = 2.05; 95% CI, 1.38-3.06) hardships compared with college-level or higher education.
Investigators observed an association between increased material hardship and myocardial infarction, peripheral neuropathy, subsequent neoplasm, seizure, stroke, reproductive disorders, amputation and upper gastrointestinal disease (P < .05 for all domains).
Material, psychological and behavioral hardships all appeared associated with somatization, anxiety and depression (P < .001 for all domains); suicidal ideation (P < .05 for all domains); and difficulty in retirement planning (P < .001 for all domains).
Survivors with any hardship experienced significantly lower health-related quality of life (P < .001 for all domains), sensation abnormality (P < .001 for all domains), and pulmonary (P < .05 for all domains) and cardiac symptoms (P < .05 for all domains).
“Survivors with financial hardship had an increased risk for symptom prevalence and impaired health-related quality of life,” Huang said. “Financial hardship also significantly impacted survivors to obtain health and life insurance, and plan for retirement.”
Huang cited measuring financial hardship by available items in the St. Jude LIFE Study and cross-sectional data as limitations.
“As financial hardship is a new focus and tools to measure this concept are still emerging, these limitations pinpoint an opportunity for future research,” Huang said. “The use of cross-sectional data precludes a temporal ascertainment between determinants and consequences of financial hardship.
“It is crucial to conduct a longitudinal study to collect financial hardship data from childhood cancer survivors over time for better quantifying the change of financial status and establishing a causal inference of financial hardship with adverse outcomes,” Huang added.
Offering effective interventions to address financial hardship could potentially improve health and social outcomes for this patient population.
“That is easier said than done and we need collaborative efforts from a systematic perspective, through health care policy, health care providers and individual patients, to find a good solution to address,” Huang said. – by Melinda Stevens
For more information:
I-Chan Huang, PhD, can be reached at Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, MS-735, 262 Danny Thomas Place, Memphis, TN 38105; email: i-chan.huang@stjude.org.
Disclosures: The authors report no relevant financial disclosures.
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